Scar-free surgery? Human anatomy provides opening, doctors say

Scar-free surgery? Human anatomy provides opening, doctors say

By Malcolm RitterAssociated PressPublished April 30, 2007

PITTSBURGH -- A 4-year-old boy lay on an operating table here a few weeks ago with a tumor that had eaten into his brain and the base of his skull. Standard surgery would involve cutting open his face, leaving an ugly scar and hindering his facial growth as he matured.

But doctors at the University of Pittsburgh Medical Center knew a way to avoid those devastating consequences -- they removed much of the tumor through the boy's nose.

Since then, doctors in New York and France announced removal of gallbladders through the vaginas of two women. And doctors in India say they have performed appendectomies through the mouth.

It's a startling concept and perhaps unpleasant to contemplate. But researchers are exploring ways to do surgery using slender instruments through the body's natural openings, avoiding cutting through skin and muscle.

Many questions remain about the approach. But doctors say it holds the promise of a faster recovery with less pain and no visible scars. And in the brain, it can avoid a need for manipulating tissue that could disturb brain and eye function.

For abdominal surgeries, going through the mouth, vagina or rectum would avoid the need to cut through sensitive tissues.

Some abdominal surgeries, such as bowel operations, can require patients to spend a week or more recovering at home. With the natural-opening surgery, the theoretical hope is that "they really can go back to work the next day," said Dr. David Rattner of Massachusetts General Hospital.

Sometimes doctors even pass up one natural body opening for another. On the same day they treated the 4-year-old, surgeons in Pittsburgh operated on neck vertebrae of an elderly man through his nose. Usually, this operation would have been done through the mouth.

But going through the nose meant the patient could start eating right away rather than waiting a few days. And he avoided the risks of a feeding tube and a surgical hole in his throat to breathe, said neurosurgeon Amin Kassam.

The key to operating through body openings: specialized slender instruments that can be inserted into the natural channels, along with devices that provide light and a video camera lens at the site of the surgery. Physicians watch their progress on video screens as they manipulate the surgical instruments.

It's much like laparoscopic surgery, which revolutionized the operating room; for many operations, long incisions have been replaced with three or four holes, each maybe a quarter-inch wide.

The natural-opening approach holds the promise of going a step beyond -- eliminating the need for such punctures.

"Getting rid of them completely is going to be not an evolutionary step, but a revolutionary step," said Dr. Marc Bessler of New York-Presbyterian Hospital/Columbia University Medical Center.

He led the surgery in New York that detached and removed a woman's gallbladder through her vagina. The team also inserted laparoscopic instruments into two small incisions in her abdomen, using one to hold tissue out of the way.

A week after that surgery was announced, a French doctor said his team had removed a woman's gallbladder through her vagina without any abdominal incisions. Instead, the team pierced her abdomen with a needle about a 10th of an inch wide. The needle was equipped with a video camera system and also enabled doctors to inflate the abdomen to create a working space.